Systolic Heart Failure: Types, Symptoms, Causes, Diagnosis & Treatment

What is Systolic Heart Failure?

Systolic heart failure is a type of heart failure that occurs when the heart’s left ventricle is unable to contract (squeeze) normally. This means that the heart is not able to pump blood as efficiently as it should, leading to reduced blood flow and insufficient oxygen delivery to the body’s tissues and organs.

Systolic heart failure is usually caused by damage to the heart muscle, which can be due to a number of factors, including coronary artery disease or high blood pressure. The symptoms of high blood pressure may include headaches, dizziness, blurred vision, shortness of breath, chest pain, fatigue, swelling in the feet and ankles and heart attack.

Types of Systolic Heart Failure

There are mainly two types of Systolic Heart Failure

• Acute Systolic Heart Failure

• • Acute systolic heart failure refers to the sudden onset or worsening of heart failure symptoms due to a rapid decrease in the heart’s ability to contract effectively.
  • This can be triggered by various factors, such as a heart attack, severe hypertension, or a sudden increase in the workload on the heart.
  • Patients with acute systolic heart failure often experience a rapid onset of symptoms, which may include severe shortness of breath, extreme fatigue, fluid retention leading to swelling in the legs and ankles (oedema), and difficulty lying flat due to respiratory distress.
  • Acute systolic heart failure can also be associated with arrhythmias, which are abnormal heart rhythms that can further impair the heart’s pumping function.

• Chronic Systolic Heart Failure
  • Chronic systolic heart failure is characterised by a long-term and progressive decline in the heart’s ability to pump blood effectively.
  • This condition typically develops over a period of months or years and is often a result of underlying heart conditions, such as coronary artery disease, hypertension, or prior heart attacks, which lead to damage to the heart muscle.
  • Patients with chronic systolic heart failure may experience symptoms that worsen over time, including fatigue, shortness of breath during physical activity or even at rest, persistent cough or wheezing, and fluid retention causing swelling in the lower extremities. Proper management and lifestyle changes are crucial in improving the quality of life and slowing the progression of chronic systolic heart failure. 

Causes of Systolic Heart Failure

Systolic heart failure occurs when the heart’s left ventricle (LV) becomes weak and cannot contract effectively, leading to a reduced ability to pump blood throughout the body. 

Several factors can contribute to the development of systolic heart failure, including:

• Coronary Artery Disease: The most common cause of systolic heart failure is coronary artery disease, where the blood vessels that supply the heart muscle become narrowed or blocked, leading to reduced blood flow to the heart. This can result in damage to the heart muscle, leading to systolic dysfunction.
• Heart Attack: A heart attack occurs when there is a sudden blockage of blood flow to a part of the heart muscle. The lack of oxygen and nutrients during a heart attack can cause permanent damage to the heart tissue, leading to systolic heart failure.
• High Blood Pressure (Hypertension): Persistent high blood pressure puts extra strain on the heart, causing the LV to work harder to pump blood. Over time, this can lead to LV systolic dysfunction and heart failure.
• Cardiomyopathy: Cardiomyopathy refers to diseases that directly affect the heart muscle, leading to weakness and enlargement of the LV. Dilated cardiomyopathy, a type of cardiomyopathy characterised by an enlarged LV, is a common cause of systolic heart failure.
• Valvular Heart Disease: Malfunctioning heart valves can lead to increased pressure and volume overload in the LV, eventually resulting in severe LV systolic dysfunction and heart failure.
• Arrhythmias: Abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia, can disrupt the coordinated pumping action of the heart, contributing to systolic dysfunction.
• Infections: Certain infections, such as viral myocarditis, can cause inflammation of the heart muscle, leading to impaired LV function and heart failure.
• Diastolic Dysfunction: While diastolic dysfunction primarily affects the heart’s ability to relax and fill with blood during the diastolic phase, severe diastolic dysfunction can eventually lead to systolic heart failure.
• Substance Abuse: Prolonged and excessive use of alcohol or drugs can damage the heart muscle and contribute to systolic heart failure.
• Other Risk Factors: Diabetes, obesity, and a family history of heart failure are additional risk factors that can increase the likelihood of developing systolic heart failure.

Symptoms of Systolic Heart Failure

The symptoms of systolic heart failure can vary in severity and may include:

• Fatigue: Persistent tiredness and lack of energy, even after minimal physical activity, are common symptoms of systolic heart failure.
• Shortness of Breath: Patients may experience difficulty breathing, especially during physical exertion or while lying flat, due to fluid accumulation in the lungs.
• Reduced Exercise Tolerance: Patients may find it challenging to engage in physical activities they were able to perform easily before.
• Swelling (Oedema): Fluid retention can lead to swelling in the legs, ankles, feet, and sometimes in the abdomen.
• Persistent Coughing: A chronic cough, often accompanied by white or pink phlegm, can be a symptom of fluid accumulation in the lungs.
• Rapid or Irregular Heartbeat: Heart palpitations or sensations of a rapid or irregular heartbeat may be experienced due to the heart’s inability to pump blood efficiently.
• Decreased Appetite: Patients with heart failure may experience a loss of appetite or feelings of nausea.
• Sudden Weight Gain: Unexplained weight gain over a short period, usually due to fluid retention, can be a sign of systolic heart failure.
• Dizziness or Fainting: Reduced blood flow to the brain can cause dizziness or fainting spells.

Diagnosis & Test for Systolic Heart Failure

• Medical History and Physical Examination: The healthcare provider will inquire about the patient’s symptoms, medical history, family history of heart disease, and risk factors. A thorough physical examination may reveal signs such as fluid retention (oedema), abnormal heart sounds (murmurs), rapid or irregular heartbeat, and lung crackles.
• Blood Tests: Blood tests can provide valuable information about the levels of certain substances in the blood, such as B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), which are often elevated in heart failure.
• Echocardiogram: An echocardiogram is a non-invasive test that uses sound waves to create images of the heart’s structure and function. It is the primary test for diagnosing systolic heart failure, as it can assess the heart’s ejection fraction (EF) – the percentage of blood pumped out of the left ventricle with each heartbeat. Reduced ejection fraction (typically less than 40%) is indicative of systolic heart failure.
• Electrocardiogram (ECG or EKG): An ECG records the electrical activity of the heart and can help identify abnormal heart rhythms, previous heart attacks, and other cardiac abnormalities.
• Chest X-ray: A chest X-ray may be done to check for signs of heart enlargement, fluid accumulation in the lungs, or other abnormalities.
• Cardiac MRI (Magnetic Resonance Imaging) or CT (Computed Tomography): These imaging tests can provide detailed images of the heart’s structure and function, helping to assess heart chamber sizes, muscle thickness, and blood flow.
• Exercise Stress Test: In some cases, an exercise stress test may be performed to evaluate how the heart responds to physical activity.

Treatment for Systolic Heart Failure

The management of systolic heart failure aims to alleviate symptoms, improve quality of life, slow disease progression, and reduce the risk of complications. Treatment plans are tailored to individual patients and may include the following approaches:

• Medications: Various medications may be prescribed, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, diuretics, and aldosterone antagonists. These drugs help reduce blood pressure, improve heart function, and control fluid retention.
• Lifestyle Changes: Patients are often advised to adopt heart-healthy lifestyle changes, including a low-sodium diet, regular physical activity, weight management, and smoking cessation.
• Cardiac Rehabilitation: Cardiac rehabilitation programs may be recommended to provide supervised exercise and education on heart-healthy living.
• Implantable Devices: Some patients may benefit from implantable devices such as implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices to help regulate heart rhythms and improve heart function.
• Surgery: In certain cases, surgical interventions, such as coronary artery bypass grafting (CABG) or heart valve repair/replacement, may be necessary to improve blood flow and overall heart function.
• Transplantation: For severe cases of systolic heart failure, heart transplantation may be considered as a last resort when other treatment options are ineffective.

Conclusion

Heart failure is a complex and serious condition that can significantly impact a person’s quality of life and overall well-being. Systolic heart failure, characterised by a weakened left ventricle’s pumping ability, is one of the two main types of heart failure.

To stay informed about heart health and preventative measures, it is essential to seek reliable sources of information, you can also check out BP In Control website to find valuable insights and resources for individuals looking to understand and manage blood pressure and heart-related issues.

Remember, prompt attention to heart health, awareness of symptoms, and regular medical check-ups are essential steps in safeguarding cardiovascular well-being and maintaining a heart-healthy life.